True Confessions: I have been watching the 15th season of The Biggest Loser. I’m embarrassed to admit it because, as a Certified Eating Disorder Registered Dietitian, the Biggest Loser goes against all the principles that I know about permanent weight loss. I support moderation and balance in food and exercise. Participants of The Biggest Loser exercise 5 hours a day-about the amount of time most people work!
Last night was the finale and Rachel was awarded the grand prize. After seeing her gaunt face and bony body I’m wondering if her grand prize is Anorexia Nervosa. Yes, I know her BMI is within an acceptable range but the diagnosis of anorexia encompasses more than BMI. I wonder if she is able to consume an adequate amount of food so that she is not hungry or thinking about food all of the time. I wonder if she can eat a variety of foods, including grains and occasional sweets or desserts and restaurant foods. Does she have guilt or remorse after eating? Does she obsess about food, weight or exercise? How much does she need to exercise to maintain this new low body weight?
Anorexia Nervosa and Binge Eating Disorders are both disorders of extremes. Both are deadly and both interfere with quality of life. I hope that Rachel doesn’t end up spending her $250,000 prize on eating disorder treatment.
We live in toxic environment for eating disorder recovery. We are constantly bombarded with media messages that thinness equals perfection, success and beauty. Add that to our own relentless negative self talk that we are not good enough, not thin enough, not smart enough, and just not enough can take a toll on fragile tools of recovery. Here are the top 5 ways to prevent relapse.
1. Avoid the scale. Weighing, for most people, is a surefire way to slide the slippery slope to relapse. Most people struggling with eating disorders, distortions and low body esteem are likely to misinterpret their weight, regardless if their weight is higher or lower than expected. If their weight is higher than expected, feelings of being out of control, self loathing and body hatred are common. This can lead to more food restriction and excessive exercise. Sometimes weighing can trigger overeating. The person struggling with the eating disorder may feel so frustrated and defeated, they end up over or binge eating. This may go on for days or months until the next cycle of restricting.
If weight is lower than expected, the reward center of the brain does a happy dance. Fireworks explode and the Hallelujah chorus breaks out….until the person with the eating disorder looks down. “Hmmmm, one more pound and my stomach will be flat.” And thus begins the never ending quest for perfection.
2. Avoid “Recovery” Instagram, Tumblr, and similar sites. These so-called recovery accounts are another quick route to a rocky recovery. These sites typically advertise a person’s lowest weight, goal weight, current weight and pictures of stomachs, thighs and food. Is it really helpful to know all of this information? Those struggling with eating disorders tend to be a competitive group and these pictures are an invitation to relapse. Some of my clients also find talking about recovery or reading recovery books or blogs can be triggering. The authors often tell stories about the worst of times in the midst of their eating disorder which can lead my clients to minimize their own issues with food and body image. Perhaps even worse, my clients feel they are “failing recovery.”
3. Follow your meal plan. If you are in recovery from an eating disorder it is probably safe to assume that your hunger and fullness cues are faulty. Continued under eating causes hunger cues to disappear. Additionally depression and anxiety can lower hunger and appetite. Continued overeating creates an increased hunger. Most people in recovery need to use a meal plan as their guide for at least a year before embarking intuitive eating. Meal plans teach normal eating habits and skills that need to be relearned before doing it on your own. Meal plans normalize eating and even after hunger cues return, they provide a foundation for eating intuitively, the ultimate goal.
4. Not practicing daily gratitude. Need an attitude change? Try listing the things you are grateful for. Even negatives can turn into positives with perspective. For example, are you hating your body? Be thankful that you have a body and that you can walk, run and laugh. Gratitude can help shift values and broaden ideas.
The common assumption about people with anorexia is that they don’t eat or eat only healthy, nutritious foods, are frightfully thin and that they do not want to restore weight. This is true for some people who struggle with anorexia, but not all. In fact, people with anorexia range vastly in symptoms and appearance. The following misconceptions are things I hear regularly from my clients and families:
Myth 1. People with anorexia don’t eat. While some people with anorexia eat minimally, others eat regular meals and snacks. The commonality is that the person with anorexia consistently eats less than their body requires which leads to weight loss or maintenance of an artificially- low body weight.
Myth 2. People with anorexia only eat healthy foods. Fruits and veggies, no processed foods, whole or no grains are rigid rules of some people with anorexia, but just as many anorexics consume hamburgers, cookies and candy. How can this be? Many anorexics have figured out that quantity, not quality leads to weight manipulation. If intake is less than needs, regardless if the intake consists of calorically dense foods, weight loss is achieved. Other people with anorexia “eat for show.” In social situations, eating is normalized; however when alone the individual with anorexia makes up for eating by restricting.
Myth 3. People with anorexia are skeletal and frail. This is probably the most misunderstood myth. Because the media sensationalizes only the sickest girls with anorexia, our society tends to think that anorexia is defined as those girls whose appearance is extreme. The other reason this is difficult to understand is because all bodies are different. Weighing less than 85% of expected weight differs since expected weight is dependent on many factors including ethnicity, genetics, age and body frame.
Myth 4. If someone has been thin throughout her life, she doesn’t have a problem. In some cases a child or adolescent who has always been thin increases in height but does not keep up with expected weight gain.
Myth 5. People with anorexia do not want to gain weight. Some people who struggle with anorexia have a realistic body image and do in fact want to restore weight.
Everyone knows someone with an eating disorder and just because a person eats and looks “OK” doesn’t mean that she is healthy.
Article submitted by R.S.
My eating disorder used to thrive on my phone. I had an eating disorder “folder” filled with apps that let me obsessively track calories, look at triggering stuff on Tumblr, etc. It wasn’t healthy at ALL.
And I read an article placing a lot of blame on technology because of this, yet, despite my experience, I’m going to have to actually disagree. Why?
Because now I have a “recovery” folder, and I really think it has the potential to be just as helpful as the old folder was triggering. And because of this, I really think that it depends on the emotional state of the person. Yeah, technology can exacerbate the issue, but that isn’t going to happen if a person simply just doesn’t have an eating disorder! And technology can be incredibly helpful as well.
The app that pushed me to write this article is called “Recovery Record.” I could go on and on about how amazing this app is, but that would probably be really boring, so I won’t. I honestly don’t think it could be triggering to any person in any way, and it is just so supportive and encouraging.
Some things I LOVE about it (soooo not a complete list):
Pam Chin-Lai, MS, RD, LD, CEDRD specializes in the nutritional rehabilitation of eating disorders in children, adolescents and adults.